Provider Demographics
NPI:1912632233
Name:PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC
Entity Type:Organization
Organization Name:PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA OPERACIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ISUANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-843-4185
Mailing Address - Street 1:PO BOX 7064
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7064
Mailing Address - Country:US
Mailing Address - Phone:787-843-4185
Mailing Address - Fax:787-843-5622
Practice Address - Street 1:917 AVE TITO CASTRO
Practice Address - Street 2:HOSPITAL EPISCOPAL SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-843-4185
Practice Address - Fax:787-843-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition